Healthcare Provider Details

I. General information

NPI: 1740414119
Provider Name (Legal Business Name): PHILIPP LEUCHT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVENUE
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

550 FIRST AVENUE MSB-617
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 212-562-4141
  • Fax: 212-263-8217
Mailing address:
  • Phone: 646-501-0291
  • Fax: 646-754-9825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number276510
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: